Monday, March 15, 2010

Health Care Battle: Has the GOP made a serious tactical error?

Last week the GOP was confronted by a plan on the part of House Speaker Nancy Pelosi (D-CA) to pull a political fast one on health reform. Her plan was to pass the reconciliation bill before passing the Senate version of the bill. This would have made garnering the votes from her sharply divided caucus much easier. In order to block this the Republicans appealed to the Senate's Parliamentarian for a ruling on whether one can present for a vote a bill on reconciliation for another bill not yet passed. The GOP won that battle when the parliamentarian ruled that before amendments can be presented for the process known as reconciliation (to avoid a GOP sponsored filibuster) the original bill MUSTfirst be both passed by the House and signed by the President into law.

The GOP was ecstatic. They had just stopped a political flanking attack, and they felt sure made it much harder for House members to vote for a bill that nearly everyone agrees is horribly flawed. I believe they may have been mistaken.

Recall that the Senate bill contains provisions for special kickbacks and sweetheart deals for a few states like Louisiana and Nebraska as well as provisions that are deeply unpopular with most mainstream Americans. IF the House does pass the original Senate bill which is now their intention, and the president then signs said bill it will become the law of the land with all its warts. Then will come the various amendments to this bill which the Democrats want passed by reconcilaition since the GOP has vowed massive resistance to any meaningful health care reform. The GOP intends to challenge every letter of every word in the amendments invoking what is called the "Byrd Rule" (so named for Senator Robert Byrd D-WV who devised the system to prevent an end run around the Senate filibuster for anything other than purely fiscal matters). If they are successful they will effectively kill many, possibly most, of the amendments to the Senate bill.

But wait.

Recall that the Senate's bill will have already been passed by the House and signed by the President. The GOP will now be in a different situation. National universal health insurance (however deeply flawed) will now be the law. What the GOP will be fighting are amendments to fix universally recognized problems with the legislation. Do they want to go on record trying to preserve the "Louisiana Purchase" or the "Corn Husker Kickback" that they so justly lampooned last summer and fall?

I think the Republicans miscalculated and will find themselves in a situation where they are going to have to accept at least some of the amendments presented by the House. Otherwise they will be raked over the coals for their hypocrisy in November. Also confronted with the reality of universal health insurance being law and the extreme unlikelihood of ever being able to repeal it, I suspect they may moderate their position and offer to let some of the amendments go through, perhaps in exchange for some of their own being added. We will see.

One thing however seems clear. If the Democrats can get the votes to pass the Senate's bill as is, the GOP will find it politically challenging to continue their policy of just say "NO."

David, did the government "screw up" the road you drove to work on today? We often hear about how the government "screws everything up" from the right but the fact is that there are many things that the "government" does very well. Medicare falls into the category of what the government does well. Since the introduction of Medicare, we've seen major advances in medical technology. Most of these advances can be directly attributable to Medicare. Medicare provided financing for the sickest patients which provided incentives for healthcare providers to devote resources to treating the sickest patients.

Medicare isn't an efficient system because there are few cost controls besides a government set fee schedule. But Medicare is efficient in the sense that it pays its bills quickly and with little hassle required by the provider. It is easy for patients to understand what their out of pocket costs will be. There is little question about eligibility and covered benefits.

Medicare is a "financial millstone" because it has no cost controls. As I wrote, the only cost controls in Medicare is the non-negotiable fee schedule that is set by the federal government. But Medicare has no case management, no cost benefit studies of medical technologies, etc.

Young people benefit from investment in helping people over 65. Look at improvements in cancer survival rates over the 30 or so years. It's a dramatic improvement and the federal government (either through Medicare or through federal research) is due much of the credit. The vast majority of patients of a provider like MD Anderson are Medicare beneficiaries.

Medicare was created in the mid 1960's and look at all of the advances in medical technology that have come about since the mid 1960's. Since everything in healthcare is about how it is financed, I doubt it's a coincidence.

Medicare is entirely too expensive because there is no political willpower to impose cost controls (on the left it's not fair and on the right it's "death panels"). But overall Medicare "works" in the sense that it is an efficient payor. It sets the standard for what is a covered benefit. It provides coverage for those who would be unable to purchase insurance on their own and infuses trillions of dollars into the healthcare system.

The road no, the process it used to make the road oh yeah. I work for the government and so does my why. She actually works for the part that does state contracts with vendors. The waste is unreal. It isn't her fault it is the rules that the government has to play by. Sometimes even we (the government) mean well but the road to good intentions sometimes lead to hell.

The health care bill wants to expand medicare while more and more doctors won't take it because the repayment is so low all the while the government plans to lower those repayments.

No doubt something needs to be done. Heck I would be for single payer over this piece of crap legislation.

I'm not arguing that the government is perfect just that you can't make the case that everything the government touches is "screwed up." There is certainly waste in public works but would the private sector work better?

I often hear about doctors refusing to take Medicare because the payments are low but I've never seen it in real life. No provider I've ever worked for has stopped seeing medicare patients. Medicare reimbursement is unfairly low which puts pressure on the commercial payors to make up the difference (cost shifting) but there are ways to make money treating Medicare patients (namely economy of scale). Further the administrative overhead associated with treating a Medicare patient is much lower than a patient with private insurance.

John's response made me chuckle, but I will say to Anon., in fairness, I have no way of knowing if the private sector would do a better job with the roads or even if such a thing is possible on a broad scale. In some cases, though, the government isn't doing such a great job, either, especially in these budget-constrained times.

This whole package reminds me of what Chesterton said 100 years ago; when the true religion is destroyed evil runs loose and does harm.....but good runs loose and does far more harm!!!!Obama is a force of great harm wrapping his ideas in the good.very clever.....and the people love it. go to the desert and hide before it is all too late.

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